Peritoneal dialysis is a procedure in which a sterile, balanced salt solution is placed into the peritoneal cavity. The solution plus impurities removed from the blood is then removed at some time later (one-half to 10 hours) and replaced. During this exchange of fluid, toxic soluble materials are removed from the patient. Peritoneal dialysis is effective for treatment of kidney failure and has been utilized for about thirty years for this purpose. For the successful use of peritoneal dialysis, however, an access device must be utilized which allows continuous access to the peritoneum, without repeated puncture, and without subsequent infection along the prosthesis. A variety of prostheses have been used in the past, but by far the most successful has been the Tenckhoff catheter. Developed in the mid 1960's, this catheter is a silicone rubber tube with numerous drainage holes on its inner portion. One or two dacron "cuffs" are placed in the subcutaneous tissue or in the muscle layer of the patient. These cuffs serve to limit peritoneal fluid leakage out of the peritoneum and bacterial migration along the catheter from the outside. These cuffs are approximately 1/2" in total diameter and the silicone tube is slightly less than 1/4" in diameter.
The Tenckhoff catheter may be placed surgically, making an incision over the abdominal musculature which is large enough to allow placement of the cuffs in the subcutaneous tissue. Alternately, the Tenckhoff catheter may be placed using a "Trocar[ developed by Dr. Tenckhoff, and described in an article by him. "Catheter Implantation", Dialysis Transplantation, October 1972, p. 18-20. This Trocar allows placement of the smaller silicone tube portion of the catheter inside the abdominal cavity, and placement of the larger cuff outside the abdominal cavity in the subcutaneous tissue, all utilizing the single insertion device. This device conforms to the shape of the silicone tube, and has a wide channel for the cuff. The device separates, after the insertion of the silicone tube portion into the abdomen, thus reducing the difficulty of having the cuff portion go through the narrowest part of the trocar device.
Although this trocar may be successfully used at the bedside by any physician, it does have several drawbacks. First, the steel portion entering the abdomen is relatively large, being approximately 1/4" in diameter. Second, the insertion of the abdominal portion must be done "blind" occasionally causing difficulty in cases of previous surgical operations. Third, the device is somewhat bulky to operate and separation of halves and removal of the halves around the cuff is often difficult. Fourth, the device is not airtight, therefore, use during inspection of the abdomen under peritoneoscopy is difficult (since a pressurized volume of air cannot be kept in the abdonmen with this device inserted).
Since the development of the Tenckhoff trocar, there have been no alternate or new devices for placement of the Tenckhoff catheter. Other implantable access devices have been developed utilizing the dacron cuff for tissue ingrowth. These have been used for arterio-venous access (for hemodialysis) and for long term venous access (as for hyperalimentation).